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  • Medicare Part D 2011 Data Spotlights

    Report

    The Kaiser Family Foundation has issued a collection of analyses related to the Medicare Part D stand-alone drug plan options available to seniors for calendar year 2011. These spotlights focuses on key aspects of the drug plan choices available and relevant trends since the Medicare drug benefit took effect in 2006. They were prepared by a team of researchers at Georgetown University, NORC and the Kaiser Family Foundation. 2012 Part D Data Spotlights Now Available…

  • Medicare Part D Data Spotlight: A First Look at Part D Plan Offerings in 2012

    Report

    This data spotlight examines the stand-alone Part D drug plan options available to Medicare beneficiaries in 2012. Medicare beneficiaries will, on average, be able to choose from 31 stand-alone Medicare Part D prescription drug plans to choose from, a new Kaiser analysis finds. Average premiums would increase by 4 percent from 2011 to 2012 if beneficiaries remain with their current plans during the open enrollment period, which begins October 15 and December 31. That represents…

  • Analysis of Medicare Prescription Drug Plans in 2011 and Key Trends Since 2006

    Report

    This report presents findings from an analysis of the Medicare Part D marketplace in 2011 and changes in drug coverage and costs since 2006. It presents key findings related to Medicare drug plan premiums, the subsidy for low-income beneficiaries, the coverage gap, benefit design and cost sharing, formularies, and utilization management, based on data from CMS for all plans participating in Part D. The analysis was conducted jointly by Jack Hoadley and Laura Summer of Georgetown…

  • Medicare Part D 2011 Data Spotlight: The Coverage Gap

    Report

    This data spotlight examines the availability of gap coverage in the private Medicare Part D drug plans offered to beneficiaries in 2011, the first year of the phase-out of the gap, as required under the 2010 health reform law. The changes for 2011 include a 50 percent discount on brand-name drugs purchased during the gap in coverage, reducing an enrollee’s potential out-of-pocket costs in the gap from about $3,600 to $1,800. The analysis was conducted…

  • Medicaid Payment for Outpatient Prescription Drugs

    Fact Sheet

    This fact sheet summarizes Medicaid’s role as the major source of outpatient pharmacy services for low-income Americans. Medicaid spent $25.4 billion on prescription drugs in fiscal year 2009, and outpatient prescription drug coverage is an optional benefit that all state Medicaid programs currently provide. Fact Sheet (.pdf)

  • The Role of Clinical and Cost Information in Medicaid Pharmacy Benefit Decisions: Experience in Seven States

    Issue Brief

    This policy brief provides perspective on the potential for using comparative effectiveness research in Medicaid pharmacy programs by looking at seven states to determine how they currently evaluate relative clinical and cost information about prescription drugs when making coverage decisions for their Medicaid pharmacy benefits. The brief was prepared by researchers at the Foundation's Kaiser Commission on Medicaid and the Uninsured and Avalere Health. Policy Brief (.pdf)

  • Managing Medicaid Pharmacy Benefits: Current Issues and Options

    Report

    This report examines reimbursement, benefit management and cost sharing issues in Medicaid pharmacy programs. The analysis, conducted by researchers from the Foundation's Kaiser Commission on Medicaid and the Uninsured and Health Management Associates, focuses on the potential of several measures recently highlighted by Health and Human Services Secretary Kathleen Sebelius to reduce Medicaid pharmacy costs and is informed, in part, by the perspectives of a group of Medicaid pharmacy administrators convened by the Foundation in…

  • Understanding The Effects of The Medicare Part D Coverage Gap in 2008 and 2009

    Report

    This Kaiser Family Foundation study examines how the coverage gap in Medicare’s drug benefit known as the “doughnut hole” affects Medicare beneficiaries and their prescribing patterns. Based on actual claims data from 2008 and 2009, before the 2010 health reform law began to close the gap, the study finds that most Part D enrollees with high drug costs who fall in the gap one year are likely to do so in future years. Enrollees who…

  • Reaching for the Stars: Quality Ratings of Medicare Advantage Plans, 2011

    Issue Brief

    New: Medicare Advantage Plan Star Ratings and Bonus Payments in 2012 In 2012, Medicare Advantage plans will be awarded additional payments based on their quality ratings as a result of the 2010 health reform law. The Centers for Medicare and Medicaid Services has proposed a demonstration that would modify the quality-based payments for plans, providing additional payments for 2012 to 2014. This policy brief by the Kaiser Family Foundation examines the quality ratings of private…

  • A Primer on Medicare Financing

    Issue Brief

    As Congress and the Administration increasingly focus on the nation’s budget deficit, many policy experts and several bipartisan deficit reduction panels have proposed significant changes to Medicare to reduce federal spending and address rising health care costs. This primer provides an overview of Medicare spending trends, how the program is financed, and factors contributing to the growth in Medicare spending. Medicare now covers 47 million seniors and younger people with disabilities, with total expenditures of…